Panic Attacks and Panic Disorder: Symptoms, Causes, and When to Get Help

A panic attack is a sudden wave of intense fear with strong physical symptoms, and it can come on very quickly, sometimes for no clear reason and even during sleep [1][9]. It can feel overwhelming, but the NHS and NIMH (the U.S. National Institute of Mental Health) both say the attack itself is not dangerous, although the NHS notes that the same symptoms can also be caused by other conditions [1][9]. When attacks keep coming back and the fear of the next one starts to shape daily life, doctors call it panic disorder, and the NHS says it is treatable [1].

What a Panic Attack Feels Like

During an attack, several symptoms usually arrive together [11]. They can include [1][9][11]:

• a racing or pounding heartbeat
• shortness of breath, or a choking or smothering feeling
• chest pain
• sweating, trembling or shaking
• hot flushes or chills
• dizziness, light-headedness or feeling faint
• nausea or a churning stomach
• numbness, tingling or pins and needles
• feeling detached, or not connected to your body
• a sense of dread, a fear of losing control or a fear of dying

The American Psychiatric Association notes that attacks can be expected, such as in response to something a person fears, or unexpected, seeming to happen for no reason at all [11].

How Long Attacks Last

The NHS says most panic attacks last between 5 and 20 minutes, and some have been reported to last up to an hour [1]. NIMH describes a range from a few minutes to an hour or sometimes longer [9]. How often they happen varies widely too. NIMH says attacks can come as often as several times a day or as rarely as a few times a year [9].

Frightening, but Not Dangerous

According to the NHS, a panic attack will not cause you physical harm, and it is unlikely you will be admitted to hospital because of one [1]. NIMH adds that the physical symptoms usually settle with time, although the fear of future attacks can lead to ongoing anxiety [9]. There is an important caution alongside this reassurance. The NHS points out that most panic symptoms can also be symptoms of other conditions, so what you are feeling may not always be a panic attack [1].

Panic symptoms can feel like a heart attack, and some people seek emergency care for that reason [9][11]. NICE's information for the public says healthcare professionals first rule out a physical cause [6]. In the UK, the NHS says to call 999 if you have sudden chest pain or discomfort that does not go away, pain that spreads to your arms, neck, jaw, stomach or back, or chest pain with feeling sweaty, sick, light-headed or short of breath, because you could be having a heart attack [4]. For heart-related causes of a racing heartbeat, see Heart Palpitations: Causes, Symptoms, and When to Worry.

Panic Attack or Panic Disorder?

Having a panic attack does not mean you have panic disorder. NIMH says an isolated panic attack is not a mental disorder, and not everyone who has one goes on to develop panic disorder [9]. NICE, which writes clinical guidance in England, notes that treating a panic attack well may help limit the development of panic disorder [5].

Panic disorder is different because the attacks are recurrent and unexpected and are followed by ongoing worry about having more, or by changes in behavior to avoid them [9]. The NHS describes how this can turn into a cycle of living "in fear of fear". Avoiding places or situations in case they set off an attack can add to the sense of panic and lead to more attacks [1].

Why Panic Attacks Happen

The NHS says the exact cause is not fully understood. It is thought to be linked to a combination of things, including a traumatic or very stressful life experience such as bereavement, having a close family member with panic disorder, and an imbalance of chemical messengers in the brain [1]. NIMH notes that panic disorder sometimes runs in families and that several parts of the brain may play a role in fear and anxiety [9].

Some researchers think panic attacks work like "false alarms", where the body's survival instincts switch on too often or too strongly. NIMH gives the example of someone who feels their heart pounding, assumes they are having a heart attack, and becomes more frightened, which can feed a vicious cycle [9].

The NHS also says that sugary food and drinks, caffeine, alcohol and smoking can all make attacks worse [1].

Who Is Affected

NIMH says panic disorder often begins in the late teens or early adulthood, and women are more likely than men to develop it [9]. The American Psychiatric Association gives an average age at onset of 20 to 24 [11]. In the United States, NIMH estimates from older survey data, collected in the early 2000s, that about 2.7 percent of adults had panic disorder in the past year [10].

Agoraphobia and Other Conditions That Can Come With Panic

Agoraphobia is a fear of being in situations where escape might be difficult, or where help would not be available if things went wrong. The NHS stresses that it is not simply a fear of open spaces. Examples include using public transport, visiting a shopping center or leaving home [2]. It can develop when a person links their panic attacks to the places where they happened and then starts avoiding those places, although not everyone with agoraphobia has had panic attacks [2]. The American Psychiatric Association notes that, without treatment, agoraphobia can become serious enough that a person feels unable to leave the house [11].

The NHS says that without help, panic disorder can also raise the risk of other phobias and of alcohol or drug problems [1]. NIMH notes that some people with panic disorder also have depression or another anxiety disorder [9]. For more on these, see Depression: Symptoms and When to Seek Help and Generalized Anxiety Disorder: Symptoms and When to Seek Help.

How Panic Disorder Is Diagnosed

A GP or other clinician will ask you to describe your symptoms, how often they happen, how long you have had them and how they affect your life [1][9]. They may examine you to make sure another physical problem is not causing your symptoms [1][9]. NICE says a healthcare professional may also ask about any medicines or other substances you take, including alcohol and caffeine [8].

The NHS says you may be diagnosed with panic disorder if you have regular, unexpected panic attacks followed by at least a month of continuing worry about having more [1]. NIMH describes the same month, which can also involve fear about what the attacks mean or changes in behavior to avoid them [9]. This is something a clinician assesses in conversation with you. NICE notes there is not enough evidence to recommend a self-report questionnaire for diagnosing it [5].

How Panic Disorder Is Treated

The NHS says treatment aims to reduce the number of attacks and ease symptoms, and that talking therapies and medicine are the main treatments [1]. NICE takes a stepped approach for adults in England. It suggests starting with self-help for mild to moderate panic disorder. For moderate to severe panic disorder, it suggests considering CBT, or medicine if the condition is long-standing or psychological treatment has not helped or was declined [5]. NICE's public information adds that psychological treatment, medicine and self-help have all been shown to work, and that in studies the benefits of psychological treatment lasted the longest [7].

Cognitive behavioral therapy (CBT) is the therapy most often recommended. NIMH calls it the "gold standard" of psychotherapy for panic disorder [9], the American Psychiatric Association describes it as a first-line treatment for many anxiety disorders [11], and the World Health Organization says therapies based on CBT have the most evidence [12]. CBT helps people change how they think about and react to the feelings that come before or during an attack, and it often includes gradually facing feared situations or body sensations [9][11]. NIMH notes that therapy can take place in person or by telehealth [9].

In England, you can refer yourself directly to an NHS talking therapies service, or ask a GP to refer you [1]. If you and your doctor think medicine might help, your doctor will talk through the options with you, including the risks and possible side effects [1][7]. NIMH says finding the right treatment may take some trial and error and time [9]. If two treatments have not helped, NICE advises discussing a referral to a specialist [7].

Support groups can be part of self-help, and some are run by people who have had panic disorder themselves [7]. The NHS says it might help to speak to other people with the condition, and suggests asking your GP about support groups near you [1]. The NHS also suggests connecting with a charity, so national charities and local support groups are other places to find that contact [1].

What You Can Do During an Attack

The NHS suggests these steps the next time you feel an attack coming on [1]:

• stay where you are, if possible
• breathe slowly and deeply
• remind yourself that the attack will pass
• focus on positive, peaceful and relaxing images
• remember that it is not life threatening

To help prevent further attacks, the NHS mentions regular exercise, breathing exercises for stress, yoga or pilates, and a self-help book based on CBT, which your GP can recommend [1]. NIMH adds that a healthy lifestyle can help, but it cannot replace treatment [9].

Children and Teenagers

The NHS says a child with signs of panic disorder should see a GP, who will take a detailed history and examine them to rule out physical causes. The GP may refer them to a specialist, who may recommend CBT [1]. In the United States, NIMH estimates from older survey data that about 2.3 percent of teenagers aged 13 to 18 have had panic disorder at some point [10].

Supporting Someone With Panic Attacks

If someone close to you has panic attacks, NIMH suggests setting aside time to talk, reassuring them of your support, and being kind and patient, since managing panic can involve setbacks [9]. NIMH also suggests learning about the signs, symptoms and treatment options [9].

When to Get Help

Routine help: the NHS says to see a GP if you have symptoms of panic disorder, and that it is best to get help as soon as you can [1]. If going in feels hard, the NHS notes that you can ask for a telephone appointment [2]. In the US, NIMH says it is time to seek professional help if anxiety starts to cause problems at school, at work or with friends and family, and suggests starting with a primary care provider, who can refer you to a mental health professional [9].

Urgent help in the UK (NHS) [3]:

• Get advice from 111 and choose the mental health option, or ask for an urgent GP appointment, if you need urgent help for your mental health.
• Call 999 or go to A&E now if someone's life is at risk or you do not feel you can keep yourself or someone else safe.
• For free listening support, call Samaritans on 116 123. People under 19 can call Childline on 0800 1111.

Urgent help in the US (NIMH) [9]:

• If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988, or chat at 988lifeline.org.
• In life-threatening situations, call 911.

Questions to Ask Your Healthcare Team

NICE suggests questions such as these [7][8]:

• What are the treatments for panic disorder, and who can provide them?
• Do I have a choice about which treatment I have?
• When should I start to feel better, and what should happen if I do not?
• Who can I contact in a crisis?
• Do you have any information for my family or carers?

Conclusion

Panic disorder can make everyday places feel off-limits, but it is treatable [1]. Telling a GP or primary care provider what has been happening opens the way to therapy, self-help and a plan that fits you. Before that appointment, it can help to write down your symptoms and how long you have had them, since NICE suggests telling your GP about both [8].

Medical Disclaimer

This article is for general information and does not replace advice from a qualified health professional. If you are worried about your safety or someone else's, get emergency help straight away.